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Hypertensive Mediated Organ Damage and Hypertension Management. How to Assess Beneficial Effects of Antihypertensive Treatments?

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Abstract

The presence of hypertensive mediated organ damage is related to increased vascular risk and mortality and its prevention should be a therapeutic target and a surrogate marker of in/adequate blood pressure control. In old adult hypertensive patients the therapeutic target should be to prevent major cardiovascular events, but in young hypertensive subjects the focus should be pointed on preventing the development of hypertensive mediated organ damage, since most of the hard events are preceded by functional and structural tissues injury. Hypertension Guidelines of the European Society of Cardiology and European Society of Hypertension recognizes that some variables like electrocardiographic or echocardiographic left ventricle hypertrophy, chronic kidney disease or advance retinopathy, all considered as hypertensive mediated organ damage, may be modifiers of cardiovascular risk estimated by the SCORE system, and for that reason they should be screened in hypertensive patients. It is well known the problem of limited health systems financial resources in many low and even median income countries which precludes the possibilities of generalizing the search for hypertension mediated organ damage in all hypertensive patients. In these scenario the recommendation to perform a detailed screening should be critically evaluated. Some questions remained unanswered: the screening generalization of hypertensive mediated organ damage should modify the cardiovascular risk score of the patients, if its presence could modify the therapeutic approach, and as a consequence, if the treatment adjustment should prolong life expectancy and ameliorate the quality of life.

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References

  1. Piskorz D. Hypertension: the clinical view. In: López Santi R, Lorenzatti A, Piskorz D, editors. Cardiometabolism, from the pathophysiology to the therapeutic. Buenos Aires Autonomous City: Capital Intelectual; 2015. p. 91–6.

    Google Scholar 

  2. Piskorz D. Cardiovascular and Kidney Disease: two paths of the same condition. Salud (i) Ciencia. 2010;17:745–8 (Salud i Ciencia ISSN 1667-8982).

    Google Scholar 

  3. Vernooij JWP, van der Graaf Y, Nathoe HM, Bemelmans RHH, Visseren FLJ, Spiering W. Hypertensive target organ damage and the risk for vascular events and all-cause mortality in patients with vascular disease. J Hypertens. 2013;31:492–500.

    PubMed  CAS  Google Scholar 

  4. Piskorz D, Bongarzoni L, Citta L, Citta N, Citta P, Keller L, Mata L, Tommasi A. Functional organ damage in cardiovascular low risk patients with high central aortic pressure. High Blood Press Cardiovasc Prev. 2015;22:281–7.

    PubMed  Google Scholar 

  5. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I. 2018 ESH/ESC Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2018;36:1953–2041.

    PubMed  CAS  Google Scholar 

  6. Najjar SS, Scuteri A, Lakatta EG. Arterial aging: is it an immutable cardiovascular risk factor? Hypertension. 2005;46:454–62.

    PubMed  CAS  Google Scholar 

  7. Den Ruijter HM, Peters SA, Anderson TJ, Britton AR, Dekker JM, Eijkemans MJ, Engström G, Evans GW, de Graaf J, Grobbee DE, Hedblad B, Hofman A, Holewijn S, Ikeda A, Kavousi M, Kitagawa K, Kitamura A, Koffijberg H, Lonn EM, Lorenz MW, Mathiesen EB, Nijpels G, Okazaki S, O’Leary DH, Polak JF, Price JF, Robertson C, Rembold CM, Rosvall M, Rundek T, Salonen JT, Sitzer M, Stehouwer CD, Witteman JC, Moons KG, Bots ML. Common carotid intima-media thickness measurements in cardiovascular risk prediction a meta-analysis. JAMA. 2012;308:796–803.

    Google Scholar 

  8. Kadota A, Miura K, Okamura T, Fujisoshi A, Ohkubo T, Kadowaki T, Takashima N, Hisamatsu T, Nakamura Y, Kasagi F, Maegawa H, Kashiwagi A, Ueshima H, SESSA Research Group, NIPPON DATA80/90 Research Group. Carotid intima-media thickness and plaque in apparently healthy Japanese individuals with an estimated 10-year absolute risk of CAD death according to the Japan Atherosclerosis Society (JAS) guidelines 2012: the Shiga Epidemiological Study of Subclinical Atherosclerosis (SESSA). J Atheroscler Thromb. 2013;20:755–66.

    PubMed  Google Scholar 

  9. Verwoert GC, Elias-Smale SE, Rizopoulos D, Koller MT, Steyerberg EW, Hofman A, Kavousi M, Sijbrands EJG, Hoeks APG, Reneman RS, Mattace-Raso FUS, Witteman JCM. Does aortic stiffness improve the prediction of coronary heart disease in elderly? The Rotterdam Study. J Hum Hypertens. 2012;26:28–34.

    PubMed  CAS  Google Scholar 

  10. Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, Chiariello M. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials. J Am Coll Cardiol. 2010;56:2006–20.

    PubMed  Google Scholar 

  11. Lorenz MW, Polak JF, Kavousi M, Mathiesen EB, Völzke H, Tuomainen TP, Sander D, Plichart M, Catapano AL, Robertson CM, Kiechl S, Rundek T, Desvarieux M, Lind L, Schmid C, DasMahapatra P, Gao L, Ziegelbauer K, Bots ML, Thompson SG, On behalf of the PROG-IMT Study Group. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data. Lancet. 2012;379:2053–62.

    PubMed  PubMed Central  Google Scholar 

  12. Ong KT, Delermed S, Pannier B, Safar M, Benetos A, Laurent S, Boutouyrie P, On behalf of the investigators. Aortic stiffness is reduced beyond blood pressure lowering by short-term and long-term antihypertensive treatment: a meta-analysis of individual data in 294 patients. J Hypertension. 2011;29:1034–42.

    CAS  Google Scholar 

  13. Ait-Oufella H, Collin C, Bozec E, Laloux B, Ong KT, Dufouil C, Boutouyrie P, Laurent S. Long-term reduction in aortic stiffness: a 5.3-year follow-up in routine clinical practice. J Hypertens. 2010;28:2336–41.

    PubMed  CAS  Google Scholar 

  14. Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001;103:987–92.

    PubMed  CAS  Google Scholar 

  15. Boekholdt SM, Kees Hovingh G, Mora S, Arsenault BJ, Amarenco P, Pedersen TR, LaRosa JC, Waters DD, DeMicco DA, Simes RJ, Keech AC, Colquhoun D, Hitman GA, Betteridge DJ, Clearfield MB, Downs JR, Colhoun HM, Gotto AM Jr, Ridker PM, Grundy SM, Kastelein JIP. Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials. J Am Coll Cardiol. 2014;64:485–94.

    PubMed  PubMed Central  CAS  Google Scholar 

  16. Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ, Koenig W, Libby P, Lorenzatti AJ, MacFadyen JG, Nordestgaard BG, Shepherd J, Willerson JT, Glynn RJ, JUPITER Study Group. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008;359:2195–207.

    PubMed  CAS  Google Scholar 

  17. Yusuf S, Bosch J, Dagenais G, Zhu J, Xavier D, Liu L, Pais P, López-Jaramillo P, Leiter LA, Dans A, Avezum A, Piegas LS, Parkhomenko A, Keltai K, Keltai M, Sliwa K, Peters RJ, Held C, Chazova I, Yusoff K, Lewis BS, Jansky P, Khunti K, Toff WD, Reid CM, Varigos J, Sanchez-Vallejo G, McKelvie R, Pogue J, Jung H, Gao P, Diaz R, Lonn E, HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2021–31.

    PubMed  CAS  Google Scholar 

  18. Fernández-Friera L, Peñalvo JL, Fernández-Ortíz A, Ibañez B, López-Melgar B, Laclaustra M, Oliva B, Mocoroa A, Mendiguren J, de Martínez VV, García L, Molina J, Sánchez-González J, Guzmán G, Alonso-Farto JC, Guallar E, Civeira F, Sillesen H, Pocock S, Ordovás JM, Sanz G, Jiménez-Borreguero LJ, Fuster V. Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: the PESA (Progression of Early Subclinical Atherosclerosis) study. Circulation. 2015;131:2104–13.

    PubMed  Google Scholar 

  19. Ruilope LM, Salvetti A, Jamerson K, Hansson L, Warmold I, Wedel H, Zanchetti A. Renal function and intensive lowering of blood pressure in hypertensive participants of the hypertension optimal treatment (HOT) study. J Am Soc Nephrol. 2001;12:218–25.

    PubMed  CAS  Google Scholar 

  20. Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med. 2001;134:629–36.

    PubMed  CAS  Google Scholar 

  21. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296–305.

    PubMed  CAS  Google Scholar 

  22. Lewis EJ, Hunsicker LU, Bain RP, Rohde RD, for The Cooperative Study Group. The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med. 1993;329:1456–62.

    PubMed  CAS  Google Scholar 

  23. Bjôrk S, Mulec H, Johnsen SA, Nordén G, Aurell M. Renal protective effect of enalapril in diabetic nephropathy. BMJ. 1992;304:339–43.

    Google Scholar 

  24. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000;355:253–9.

    Google Scholar 

  25. Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, Remuzzi G, Snapinn SM, Zhang Z, Shahinfar S, RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861–9.

    PubMed  CAS  Google Scholar 

  26. Parving HH, Lehnert H, Bröchner-Mortensen J, Gomis R, Andersen S, Arner P, Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870–8.

    PubMed  CAS  Google Scholar 

  27. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, Ritz E, Atkins RC, Rohde R, Raz I, Collaborative Study Group. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851–60.

    PubMed  CAS  Google Scholar 

  28. Viberti G, Wheeldon NM, MicroAlbuminuria Reduction with VALsartan (MARVAL) Study Investigators. Microalbuminuria reduction with valsartan in patients with type 2 diabetes mellitus: a blood pressure-independent effect. Circulation. 2002;106:672–8.

    PubMed  CAS  Google Scholar 

  29. The GISEN Group (Gruppo Italiano di Studi Epidemiologici in Nefrologia). Randomised placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet. 1997;349:1857–63.

    Google Scholar 

  30. Appel LJ, Wright JT Jr, Greene T, Godoa LY, Astor BC, Bakris GL, Cleveland WH, Charleston J, Contreras G, Faulkner ML, Gabbai FB, Gassman JJ, Hebert LA, Jamerson KA, Kopple JD, Kusek JW, Lash JP, Lea JP, Lewis JB, Lipkowitz MS, Massry SG, Miller ER, Norris K, Phillips RA, Pogue VA, Randall OS, Rostand SG, Smogorzewski MJ, Toto RD, Wang X, AASK Collaborative Research Group. Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease. N Engl J Med. 2010;363:918–29.

    PubMed  PubMed Central  CAS  Google Scholar 

  31. Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension. 2000;35:580–6.

    PubMed  CAS  Google Scholar 

  32. Verdecchia P, Schillaci G, Borgioni C, Ciucci A, Gattobigio R, Zampi I, Reboldi G, Porcelatti C. Prognostic significance of serial changes in left ventricular mass in essential hypertension. Circulation. 1998;97:48–54.

    PubMed  CAS  Google Scholar 

  33. Dahlôf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, Fyhrquist F, Ibsen H, Kristiansson K, Lederballe-Pedersen O, Lindholm LH, Nieminen MS, Omvik P, Oparil S, Wedel H, LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.

    PubMed  Google Scholar 

  34. Mathew J, Sleight P, Lonn E, Johnstone D, Poque J, Yi Q, Bosch J, Sussex B, Probstfield J, Yusuf S, Heart Outcomes Prevention Evaluation (HOPE) Investigators. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation. 2001;104:1615–21.

    PubMed  CAS  Google Scholar 

  35. Fagard RH, Celis H, Thijs L, Wouters S. Regression of left ventricular mass by antihypertensive treatment: a meta-analysis of randomized comparative studies. Hypertension. 2009;54:1084–91.

    PubMed  CAS  Google Scholar 

  36. Lønnebakken MT, Izzo R, Mancusi C, Gerdts E, Losi MA, Canciello G, Giugliano G, De Luca N, Trimarco B, de Simone G. Left ventricular hypertrophy regression during antihypertensive treatment in an outpatient clinic (the Campania Salute Network). J Am Heart Assoc. 2017;6:e004152. https://doi.org/10.1161/JAHA.116.004152.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Soliman EZ, Prineas RJ. Antihypertensive therapies and left ventricular hypertrophy. Curr Hypertens Rep. 2017;19:79. https://doi.org/10.1007/s11906-017-0777-3.

    Article  PubMed  CAS  Google Scholar 

  38. Xing F, Chen J, Zhao B, Jiang J, Tang S, Chen Y. Real role of b-blockers in regression of left ventricular mass in hypertension patients Bayesian network meta-analysis. Medicine (Baltimore). 2017;96(e6290):10. https://doi.org/10.1097/MD.0000000000006290.

    Article  CAS  Google Scholar 

  39. Mottram PM, Haluska B, Leano R, Cowley D, Stowasser M, Marwick TH. Effect of aldosterone antagonism on myocardial dysfunction in hypertensive patients with diastolic heart failure. Circulation. 2004;110:558–65.

    PubMed  CAS  Google Scholar 

  40. Edelmann F, Wachter R, Schmidt AG, Kraigher-Krainer E, Colantonio C, Kamke W, Duvinage A, Stahrenberg R, Durstewitz K, Löffler M, Düngen HD, Tschöpe C, Herrmann-Lingen C, Halle M, Hasenfuss G, Gelbrich G, Pieske B, Aldo-DHF Investigators. Effect of spironolactone on diastolic function and exercise capacity in patients with heart failure with preserved ejection fraction: the Aldo-DHF randomized controlled trial. JAMA. 2013;309:781–91.

    PubMed  CAS  Google Scholar 

  41. Pitt B, Pfeffer MA, Assmann SF, Boineau R, Anand IS, Claggett B, Clausell N, Desai AS, Diaz R, Fleg JL, Gordeev I, Harty B, Heitner JF, Kenwood CT, Lewis EF, O’Meara E, Probstfield JL, Shaburishvili T, Shah SJ, Solomon SD, Sweitzer NK, Yang S, McKinlay SM, TOPCAT Investigators. Spironolactone for heart failure with preserved ejection fraction. N Engl J Med. 2014;370:1383–92.

    PubMed  CAS  Google Scholar 

  42. de Denus S, O’Meara E, Desai AS, Clagger B, Lewis EF, Leclair G, Jutras M, Lavoie J, Solomon SD, Pitt B, Pfeffer MA, Rouleau JL. Spironolactone metabolites in TOPCAT—new insights into regional variation. N Engl J Med. 2017;376:1690–2.

    PubMed  PubMed Central  Google Scholar 

  43. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatos GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld J, Masoudi FA, McBride PE, Peterson PN, Stevenson LW, Westlake C. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70:776–803.

    PubMed  Google Scholar 

  44. Morales Salinas A, Coca A, Olsen MH, Sanchez RA, Sebba-Barroso WK, Kones R, Bertomeu-Martinez V, Sobrino J, Alcocer L, Pineiro DJ, Lanas F, Machado CA, Aguirre-Palacios F, Ortellado J, Perez G, Sabio R, Landrove O, Rodriguez-Leyva D, Duenas-Herrera A, Rodriguez Portelles A, Parra-Carrillo JZ, Piskorz DL, Bryce-Moncloa A, Waisman G, Yano Y, Ventura H, Orias M, Prabhakaran D, Sundström J, Wang J, Burrell LM, Schutte AE, Lopez-Jaramillo P, Barbosa E, Redon J, Weber MA, Lavie CJ, Ramirez A, Ordunez P, Yusuf S, Zanchetti A. Clinical perspective on antihypertensive drug treatment in adults with grade 1 hypertension and low-to-moderate cardiovascular risk: an international expert consultation. Curr Probl Cardiol. 2017;42:198–225.

    PubMed  Google Scholar 

  45. Benjamin IJ, Kreutz R, Olsen MH, Schutte AS, Lopez-Jaramillo P, Frieden TR, Sliwa K, Lackland DT, Brainin M. Fixed-dose combination antihypertensive medications. Lancet. 2019. https://doi.org/10.1016/S0140-6736(19),31629-0.

    Article  PubMed  Google Scholar 

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    Daniel Piskorz

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Piskorz, D. Hypertensive Mediated Organ Damage and Hypertension Management. How to Assess Beneficial Effects of Antihypertensive Treatments?. High Blood Press Cardiovasc Prev 27, 9–17 (2020). https://doi.org/10.1007/s40292-020-00361-6

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